Vol.103 No.3 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 103 No. 3 March 2010
A Case of Neck and Mediastinal Gas Gangrene Using PMX
Takehiro Iki, Kazuhiko Shoji, Atsuhito Takahashi,
Masanobu Mizuta and Mami Matsubara
(Tenri Hospital)
We report a case of gas gangrene of the neck, which, although rare, may be fatal if spread to the mediastinum. A 58-year-old man seen for anterior neck swelling, sore throat, mild dyspnea, and epigastralgia was found in computed tomography (CT) to have gas spread from deep neck spaces to the lower tracheal carina of the mediastinum.
Tracheotomy and open neck debridement were conducted immediately upon admission, but planned mediastinal drainage via thoracotomy was changed to a transcervical approach via thoracoscopy due to the man's rapidly deteriorating condition. Septic shock and acute respiratory distress syndrome (ARDS) appeared during surgery. Postoperative management included a medical ventilator, antibiotics, gamma globulin, norepinephrine and two-day polymyxin B-immobilized fiber column (PMX) hemoperfusion, after which he recovered and was discharged without sequlae.
ARDS treatment requires high positive end-expiratory pressure and low-volume ventilation. PMX is also beneficial.
Key words :gas gangrene, PMX, mediastinum, ARDS, deep neck infection